1

Differentiated Care Model Standard Operating ProceduresA personalized approach to prevention, care and support for TB patients

ContextNot all TB patients are the same, nor do they all have the same type of TB. It is therefore essential to analyse the needs of high-priority patients and plan for a prioritized approach to providing TB prevention, care and support (PCS) services. High priority patients’ groups include:

This prioritized approach, is termed as the Differentiated Care Model (DCM) for providing PCS services to TB patients and their families for optimal outcomes.

The DCM is aligned with the Integrated Patient-centred Care pillar of the End TB strategy. It aims to synergise THALI efforts with those of the RNTCP field staff to provide TB prevention, care and support services that cater to the specific needs of patients and their families, by reducing duplication of efforts in

the field, while still ensuring ‘Universal Health Care’ and reach to all TB patients.

The administration of the risk and needs assessment tool (RANA) is the first step in providing prioritized support services, and is administered at the time of treatment initiation. If the risks and needs are low, patients will be provided the PCS services applicable to all patients, aligning with the national protocol.

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Key features

Objectives

Pre-requisites to implementing the DCM

� The DCM is aligned with the Integrated Patient-Centred Care pillar of the End TB strategy.

� It is a prioritized approach to treatment of high-priority patients aimed at improving treatment outcomes and reducing mortality.

� To improve treatment adherence, leading to course completion and cure of high priority patients”, thereby reaching more than 90% successful treatment outcomes.

� Presentation/sharing of the DCM with the State and District RNTCP teams, by THALI team, in Karnataka, Telangana and Andhra Pradesh for consensus.

� RANA to be administered to each patient, at the earliest – by the time of diagnosis; or atleast at the time of treatment initiation, while preparing the treatment card, for need-based services to all TB patients.

� RANA analysis to be done on a monthly basis at the district level, and shared with District TB Officers/District TB Control Offices (DTOs/DTCOs), and draw up the list of high-priority patients in each district.

� The Risk and Needs Assessment (RANA) is conducted at the time of treatment initiation to decide which package of PCS services should be provided to each patient.

� The DCM has a counselling component to address patients’ psychosocial needs.

� To create a specialised cadre of frontline workers who are trained to provide customized PCS services to patients according to their needs.

� Capacity building of the project team including the frontline workers (Community Health Workers and Outreach Workers) on the DCM.

� A handbook for the Community Health Workers (CHWs) and Outreach Workers (ORWs), has been developed to explain, which behavior change communication (BCC) tools are to be used during each visit for PCS, in intensive and continuation phases of treatment.

� Relevant Information Education and Communication (IEC) and BCC materials developed for use among regular care patients and high priority patients, to support behavior change.

Processes

Presumptive TB casesSeeking healthcare in

the public sector

Government Hospital

Risk Assessment and Need Assessment

Patient Care and Support

Treatment Outcome >90%

Diagnosis

Treatment initiation

TBHV CHW

High-priority patients and patients identified through community engagement

Pilot stage: � Rana for all patients initiated on

treatment � categorize high priority patients

on a weekly basis � Officially share with DTCO/DTO

- Weekly & Monthly � Formal confirmation from DTCO/

DTO for PCS & f/u

Integration to RNCP: � RANA at the time of treatment

initiation (while filling the patient card)

Handle each patients using standard operating procesures

CHW-Community Health Worker; DTCO-District TB Control Office;PCS-Prevention, Care and Support; TBHV-TB Health Visitor

Notification

Community Outreach & Referral by CHW

DIFFERENTIATED CARE MODEL: A PERSONALIZED APPROACH TO PATIENT CARE AND SUPPORT

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Standard approach for all TB patients

Steps Activity Intensive Phase (IP)

Continuation phase (CP)

Materials (IEC/BCC) Result/Outcome

1. Psycho-social counselling

� Reassurance � Counselling

y Disclosure y Co-morbidity y Lifestyle/ habits

� Family support � Stigma reduction � Support groups

IP visit -1,2,3,4

CP visit - 1,2,3,4 (reinforce the message)

- Disclosure- Patient Information Brochure (PIB)- Bullet- TB Vruksha- Idly Vada

� TB status disclosed � Family/care-giver

take care of treatment adherence

� Patient attends support group meeting

2. Nutrition support

� Nutritional advice � Nutritional linkages

y Public Distribution System (PDS)

y Local leaders y NGOs, CSOs y Panchayati Raj

Institutions (PRI) � Direct Benefit

Transfer (DBT) linkage � Family members

education on Nutrition

IP Visit -1,2 & 3

CP visit -1,2,3,4 (reinforce the message)

- Nutrition- Recipe book and meal planner- Patient Information Brochure

� Nutrition chart made by family, facilitated by CHW (each patient based on their dietary habits)

� Patients consume nutritious food daily

� Completed formality (prerequisites) for DBT linkage

3. Infection prevention

� Cough Hygiene � Sputum disposal � Contact screening � INH prophylaxis

treatment (IPT) linkage

IP visit -1,2 & 3

CP visit – 1,2,3,4 (reinforce the message)

- Leaflet on cough hygiene- Patient Information Brochure

� Patient follows cough hygiene and sputum disposal

� Family members screened

� Children <6 yrs receive IPT

4. Linkages and support

� Social Security linkage � DBT Linkage � Livelihood linkage � Local philanthropists’

linkage � Health insurance linkage

IP visit –2,3 & 4

CP visit – 1,2,3,4 (reinforce the message)

� Patient linked to social security schemes, DBT, livelihood, health insurance etc. as required.

5. Medical support

� Post-diagnosis support � Adherence support &

monitoring � Patient status evaluation � Side effect/ symptom

management � Tertiary care linkage

IP visit – 1,2,3,&4

CP visit – 1,2,3,4 (reinforce the message)

- TB Vruksha- Bullet

� Patient adheres to treatment protocol

� Clinical improvement observed.

� Weight gain recorded � Side effects are addressed � Patients linked to tertiary

care

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High-priority Patients – Elderly (>60 years)

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Counselling � Understanding and identifying any possible neglect

� Identifying and educating primary care givers on TB disease, drugs and follow up

� Ensuring that the primary caregiver understands the importance of providing regular meals to the patient.

IP visit – 1,2,3,4

CP visit 1,2,3,4

Recipe Booklet

� Patient adheres to regular treatment

� Patient gains weight

Medical support � Verbal screening for other medical illnesses - Diabetes, Hypertension etc.

� Ensuring treatment and follow up of medical illnesses with relevant specialists (support in collecting medicines etc.)

� Screening of children at home/ family for TB

IP visit – 1,2,3,4

CP visit – 1,2,3,4

TB Vruksha � Patient adheres to regular treatment

� Patient gains weight

Elderly patients over 60 years of age

Patients who are living alone

Patients who were treated previously, and had taken

medication irregularly

DRTBPatients

Patients consuming

alcohol

Patients co-infected with HIV

Patients with diabetes

THALI targets seven categories of patients through its differentiated care model.

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5

High-priority Patients – Previously treated

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Counselling � Identifying and understanding reasons for taking medications irregularly previously

� Providing appropriate counselling and education support to the patient and family

� Ensuring they understand the advantages of regular medicine and disadvantages of irregular medicine (DR TB etc.)

IP visit – 1,2

- TSG

- Bullet

- TB Vruksha

- Thoogi Nodi

- Idli-Vada flashcards

� Patient adhere to regular treatment despite side effects and complete the course of treatment

� Sputum conversion

Medical support and linkages

� Facilitating linkages for getting injections regularly (for patients who have already started injections before modified guidelines)

� Ensuring universal DST, before initiation of treatment.

� Ensuring screening for HIV and DM, which may cause repeated episodes of TB.

IP visit – 1,2,3

Right Step � Patient tested for CBNAAT to know/ rule out the status of DR TB

High-priority Patients – Living alone/without family support

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Counselling � Understanding the reason for living alone (job-related etc.) and exploring support systems in neighbourhood.

� Facilitating support from family or friends or colleagues (respecting the patient’s choice)

� Assisting in disclosure to caregiver

� Working out reminder systems like SMS, alarm clocks, Medication Event Reminder Monitor System (MERM) for medicine intake

IP visit – 1,2,3,4

Disclosure � Family member/ a friend supports the patient

� Patient adheres to regular treatment

Linkages � Creating linkages to Careline or support group meetings

IP visit – 2,3,4

CP visit – 1,2 � Patient is linked to Careline and adheres to regular treatment

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High Priority Patients – DR-TB

High-priority Patients – Alcohol Dependent

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Family/care-giver counselling

� Counselling and educating the patient and family on duration of treatment

� Assessing adherence fortnightly and providing need-based counselling to patient and family

� Ensuring they understand the side effects of medication and their effective management

IP visit – 1,2,3,4

CP visit – 1,2,3,4

- TSG - Portion of DR TB Management

- Bullet

- TB Vruksha

� Adhere to regular treatment

� No complications due to pill burden

Linkages � Facilitating linkages for receiving injections regularly

� Facilitating tertiary care admissions as and when required

IP visit – 1,2,3,4

CP visit – 1,2,3,4

List of Tertiary care hospitals with address to provide to the patient

� Patient takes injections regularly

� Management of drug reactions/side effects

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Family/caregiver counseling

� Counselling and treatment literacy for family members

� Ensuring that one primary care giver takes the responsibility of giving Anti TB treatment (ATT) daily without fail

� Educating the family and primary caregiver on the importance of providing regular meals

IP visit – 1,2,3

CP visit – 1,2,3,

- Thoogi Noodi - TB Vruksha- Recipe book and meal planner

� Patient takes ATT regularly

� Family/care-givers take care of adherence

� Patient and family members attend support group meeting

Linkages � Facilitating linkages to de-addiction services and/or higher level medical facilities

� Involving Key opinion leaders (KOL) in case of domestic violence etc.

IP Visit – 3,4

CP visit – 1,2

- Patient Information Brochure (PIB)

� Patient adheres to treatment regularly

� Domestic violence, if any, it is addressed.

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High-priority Patients – TB-HIV

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Medical support � Facilitating ART initiation IP visit – 1,2

- Treatment Support guide (TSG)- TB-HIV portion- TB Vruksha

� ART initiation

Family/Caregiver Counseling

� Identifying primary caregiver, educate on TB, HIV medications etc., along with other family members

� Educating the primary care giver about the importance of Cotrimoxazole in TB HIV co-infection

IP visit – 1,2,3

CP visit – 1,2, -TSG – TB-HIV

� Patient is on regular medication for both TB and HIV

� Improvement in CD4 count � Clinical improvement � Patient gains weight,

which is a good indicator for both TB and HIV

Linkages � Facilitating linkages with other NGOs for social entitlements and nutrition

� Motivating patients to attend Patient Support Group meetings

IP visit – 2,3

CP visit – 1,2,3,4

- TSG – TB-HIV portion

� Patient gets social entitlements

� Patient attends support group meetings.

High-priority Patients – TB-Diabetes Mellitus (DM)

Steps Activity IP CP Materials (IEC/BCC) Result/Outcome

Medical support � Facilitating linkages with clinical diabetes care

� Supporting regular monitoring of sugar levels and ensuring that diabetes under control

� Supporting the disclosure of TB status with the doctor treating diabetes for modifications in nutrition/medication if required

IP visit – 1,2,3

CP visit – 1,2,3,4

-TSG – TB-DM portion

- Recipe booklet & meal planner

- Disclosure

� Patient makes changes in diet and has an improved nutrition status

� Patient’s blood sugar under control

� Patient takes diabetic medications regularly

Family/Car-giver Counselling

� Identifying and educating the primary care giver on the importance of providing regular meals (low calorie and high protein), TB medications and diabetic medications.

IP visit – 1,2,3

CP visit – 1,2

- TSG – Nutrition - Recipe book and meal planner

� Patient adheres to regular TB treatment and diabetes treatment.

� Patient takes proper diet regularly

Supportive Supervision/Monitoring � A minimum of one visit during the IP and CP phase will

be made by the Community Coordinator/ District Program Coordinator (CC/DPC)

� During DTO monthly review meeting, review of PCS and RANA data of the high-priority patients will be done. A report will be generated and shared with the district RNTCP team and CHWs.

� Analysis of the monthly progress trend at the district level and sharing it with Frontline Workers (ORW/CHW). Identification of the cases which need attention and visiting those cases on priority, with the support of the technical team of THALI or RNTCP.

� Follow-up mechanism to be developed at a micro level for each patient so that the CC/DPC can support the patients periodically.

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AppendixBehavior Change Communication Materials (English, Kannada and Telugu)

S. No Material Communication Objectives BCC Material

1. Nutrition (flipchart) Consumption of nutritious food during TB treatment.

2. Disclosure(flipchart)

Disclosure of one’s TB status to the desired member(s) of the family to enable bet-ter support from the family, resulting in better treatment outcomes.

3. Ishte Testing for TB in case of persistent cough. A cough for more than two weeks is the most common symptom of TB.

4. One Step, the Right Step (flipchart)

Persistent cough for more than two weeks could be a symptom of TB. Get tested for TB if you havethis symptom.

5. TB Vruksha(single-page material)

Strict adherence to your course of medication will result in better treatment outcomes.

6. Bullet(Piano Folder)

Adhere strictly to the course of TB medication to improvetreatment outcomes.

7. Thoogi Nodi(flipchart)

Those who drink alcohol should not miss their dosages of medicines at any cost.

Nutrition

Confide, don't hide!

Let your loved ones support you!

DMC Center

Sputum Test

DMC

One Step,

The Right Step

Weigh the consequences

Behaviour objective:

Adhere strictly to the course of tuberculosis (TB) medication to improve

treatment outcomes.

Flow of the material:

TB can be completely cured, but one has to strictly adhere to treatment.

TB bacteria generally attack the lungs, but can affect other parts of the

body.

When treatment begins, there are some side effects which generally fade

away. The patient thinks that he is recovering quickly and that the

bacteria are losing. The patient stops treatment thinking that he is now

well, but the bacteria are still alive in his body.

They gradually become stronger and can immunity to the TB develop

medicines.

If the patient doesn't realize the importance of treatment adherence, the

bacteria become stronger and the patient has to pay the price, becoming

weaker and more sick over time.

Not every patient behaves like that. Some realize the importance of

treatment adherence and they take every dose of their medication strictly.

They realize that side effects are normal and that they will eventually fade

away, so they don't stop taking treatment in the middle. The medicines in

their bodies attack the bacteria continuously and kill them. Ultimately, the

individual wins by becoming healthy again, and the bacteria lose.

Those who adhere to the treatment choose to look after their health and

that's why they win over the disease!

Now, what do you choose? TB or Health?

Call to action:

Adherence to your course of medication better treatment will result in

outcomes.

Close the discussions with thanks.

Disclaimer: This material is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of KHPT and do not necessarily reflect the views of USAID or the United States Government.

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Bullet

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8. Idly Vada I(posters/flashcards)How long are you going to cough like this?Go, get your sputum tested!

Persistent cough for more than two weeks could be a symptom of TB. Get tested for TB if you have this symptom.

9. Idly Vada II(posters/flashcards)Don’t miss a single dose of medicationduring your treatment period!

Strictly adhere to your treat-ment regimen and complete the entire course of TB medi-cation.

10. Idly Vada III(posters/flashcards)

Do not stop taking medicine if youare consuming alcohol!

Those who consume alcohol should not miss dosages of their TB medicines at any cost!

11. Idly Vada IV

Avoid smoking during TB treatment

Avoid smoking and tobacco consumption during TB treat-ment.

12. Patient Information Brochure

Understand TB and adapt healthy behaviours to recover from TB

13 Recipe Book(Kannada only)

Maintaining one’s health through nutritious food consumption made possible through easy recipes.

14 Cough Hygiene Leaflet Maintaining cough hygiene through simple methods is essential to prevent the spread of infection

15 Treatment Support Guide

Providing information on TB, symptoms, testing, treatment, side effects, and the impor-tance of treatment adherence and a healthy lifestyle for positive treatment outcomes.

What did Mr. Idli tell Mr. Vada?

How long are you going to cough like this? Go, get your sputum tested!

Don't miss a single dose of medication

during your treatment period!

What did Mr. Idli tell Mr. Vada?

Do not stop taking medicine if you

are consuming alcohol!

What did Mr. Idli tell Mr. Vada?

Avoid smoking during TB treatment!

What did Mr. Idli tell Mr. Vada?

This is a draft copy. It is not intended for circulation. This is a draft copy. It is not intended for circulation.

Where can I get more information and treatment support?

9 Cover your mouth with a cloth when you cough. 9 Wash your hands with soap after you cough. 9 Keep your home well-ventilated.

Date of treatment initiation:

Month 1 Weight:___kg

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Month 5 Weight:___kg

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Month 2 Weight:___kg

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Month 4 Weight:___kg

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Month 6 Weight:___kg

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9 TB patients are eligible to receive Rs 500 per month for nutritional support during treatment. This direct benefit transfer (DBT) payment and will be credited to your bank account. Contact your Designated Microscopy Centre (DMC) for details.

9 Mitra: A TB Careline - This is a telephone-based service that provides information and counselling to TB patients and caregivers. Give a missed call to the 73497 78223 and the counsellor will call you back.

9 104 Helpline - This is a free call-in service that provides health related information and counselling support for all.

9 Get all the people in close contact with you screened for TB.

9 Children less than 6 years of age should be given preventive treatment for 6 months after TB is ruled out by a paediatrician.

TuberculosisSo What?!

How can I protect my family from TB? Patients/Caregivers Self-monitoring Tool

Just 3 Simple Steps

1. Timely Treatment

2. Nutritious Food

3. Healthy Lifestyle 9 Mark tick in box if medicine taken 8 Mark cross if medicine not taken

Shade the box if a doctor visit is scheduled. � Record and note your weight every month.

KHPTIT Park, 5th Floor, # 1-4, Rajajinagar Industrial Area, Behind KSSIDC Administrative Office, Rajajinagar, Bengaluru 560 044. Karnataka, IndiaT: +91 80 40400200 W: www.khpt.org

Disclaimer: This brochure is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of KHPT and do not necessarily reflect the views of USAID or the United States Government

DºÁgÀ¢AzÀ

DgÉÆÃUÀå

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Nikshay ID: DMC Name: TU Name: Date:¤PÀëAiÀiï UÀÄgÀÄvÀÄ rJA¹ ºÉ¸ÀgÀÄ nAiÀÄÄ ºÉ¸ÀgÀÄ ¢£ÁAPÀFacility Name: PRAD ID: ¸Ë®¨sÀåzÀ ºÉ¸ÀgÀÄ ¦DgïJr UÀÄgÀÄvÀÄ

Name:………………………………………………...........................................

Current Address:.……………………..…………………………….….................

Land Mark:………………………………………………………...................……...

Permanent Address: ………………………………………………...............…..

………………………………………………………………………….........................

Age: ……Yrs DOB: DD/MM/YYYY Gender: M F TGReligion: Hindu Muslim Christian Other:……………… Education: Cannot Read/Write <5 std 5-10 std. 12th Diploma Graduate Post Graduate

Marital Status: Single Married Widowed Separated/divorced ªÉʪÁ»PÀ ¹Üw: C«ªÁ»vÉ/vÀ, «ªÁ»vÉ/vÀ, «zsÀªÉ/«zsÀÄgÀ, ¥ÀævÉåÃPÀªÁVzÁÝgÉ/ «ZÉÒÃzÀ£ÀªÁVzÉ Occupation GzÉÆåÃUÀ :…………………………................................……..

Contact No Alternate No

Type of TB : Pulmonary (¦.n©) Extra Pulmonary (E.¦.n©)History of TB treatment: New TB (ºÉƸÀ PÉøÀÄ) Previously treated for TB (F »AzÉ aQìvÉAiÀÄ£ÀÄß ¥ÀqÉ¢gÀĪÀªÀgÀÄ)

Anti TB medication from: Private sector (SÁ¸ÀV) Public sector (¸ÀPÁðj)

Date of treatment initiation: aQvÉìAiÀÄÄ DgÀA¨sÀªÁzÀ ¢£À DD/MM/YYYY : ¢/wA/ªÀµÀð Treatment Regimen Initiated : DS TB DRTB

Risk Assessment and Needs Assessment C¥ÁAiÀÄzÀ CA±ÀUÀ¼ÀÄ ªÀÄvÀÄÛ CªÀ±ÀåPÀvÉUÀ¼À CAzÁdÄ

Risk assessment C¥ÁAiÀÄPÁj CA±ÀUÀ¼À CAzÁdÄ

Risk factor C¥ÁAiÀÄPÁj CA±ÀUÀ¼ÀÄAssess if present

(Y/N)

Action Taken(Y/N)

Details of Action taken PÉÊUÉÆAqÀ PÀæªÀÄUÀ¼À «ªÀgÀ

1. About TB Does patient understand TB disease and/or treatment? (n©AiÀÄ §UÉÎ CjªÀÅ) EzÉ/E®è EzÉ/E®è

Do you know what disease you have? what did the health worker say to you? How does TB spread? By air / DropletWhat is the common symptom of TB? CoughWhat is the test for lung TB? Sputum testIs TB Curable? Yes TB is curable¤ªÀÄUÉ AiÀiÁªÀ SÁ¬Ä¯É EzÉ JAzÀÄ w½¢zÉAiÀiÁ? DgÉÆÃUÀå PÁAiÀÄðPÀvÀðgÀÄ ¤ªÀÄUÉ K£ÉAzÀÄ ºÉýzÀgÀÄ? n.© ºÉÃUÉ ºÀgÀqÀÄvÀÛzÉ? (UÁ½AiÀÄ ªÀÄÆ®PÀ) n.©.AiÀÄ ¸ÁªÀiÁ£Àå ®PÀëtUÀ¼ÉãÀÄ? (PɪÀÄÄä) ±Áé¸ÀPÉÆñÀzÀ n.©. JAzÀgÉãÀÄ? (PÀ¥sÀ ¥ÀjÃPÉë) n.©. UÀÄtªÁUÀÄvÀÛzÉAiÉÄÃ? (ºËzÀÄ) n.©. UÀÄt¥Àr¸À§ºÀÄzÀÄ

Acceptance of TB disease and/or treatment• Does the patient accept that s/he has TB? gÉÆÃVAiÀÄÄ (CªÀ£ÀÄ/CªÀ¼ÀÄ) vÀ£ÀUÉ n.©. EzÉ JAzÀÄ M¦àPÉƼÀÄîvÁÛgÉAiÉÄÃ?• Is the patient ready to take treatment for long term (At least 6 months)? ¢ÃWÁªÀ¢ü aQvÉìUÉ gÉÆÃV ¹zÀÞªÁVzÁÝgÉAiÉÄÃ? • Is the patient willing to take tablets and / or injection as prescribed? ªÉÊzÀågÀÄ ¸ÀÆa¹zÀAvÉ ªÀåQÛAiÀÄÄ ªÀiÁvÉæ/EAdPÀë£ï£ÀÄß vÉUÉzÀÄPÉƼÀî®Ä vÀAiÀiÁjzÁÝgÉAiÉÄÃ?

2. About Person (ªÀåQÛAiÀÄ §UÉÎ)

Regular travel/ likely migration DUÁUÉÎ ¥ÀæAiÀiÁt/ªÀ®¸ÉAiÀÄ ¸ÁzsÀåvÉ

Co-existing condition (Write codes)a. HIV ºÉZï.L.« b. DM (qÀAiÀiÁ©n¸ï) c. Silicosis ¹°PÉÆù¸ï d. Undernutrition ¥Ë¶×PÁA±ÀzÀ PÉÆgÀvÉ e. Pregnancy UÀ¨sÁðªÀ¸ÉÜ f. Breast feeding ºÁ®Ät¸ÀĪÀÅzÀÄ G. Other Specify EvÀgÉ w½¹

Alcoholism ªÀÄzÀå¥Á£ÀzÀ ZÀl

Tobacco Addiction vÀA¨ÁQ£À ZÀl

Have you ever experienced discrimination or denial of rights because of TB? n.©. PÁgÀt¢AzÀ ¤ÃªÀÅ JAzÀzÁgÀÄ vÁgÀvÀªÀÄåªÀ£ÀÄß JzÀÄj¹¢ÝÃgÁ CxÀªÁ ºÀPÀÄÌUÀ½AzÀ ªÀAavÀgÁV¢ÝÃgÁ?

3. About family (PÀÄlÄA§zÀ §UÉÎ)

Living Alone / No Care Giver M§âgÉà fë¸ÀÄwÛ¢ÝÃgÁ?/DgÉÊPÉ ¤ÃqÀĪÀªÀj®è

Do you have the support of family members? ¤ªÀÄä PÀÄlÄA§zÀ ¸ÀzÀ¸ÀågÀ ¨ÉA§®«zÉAiÉÄÃ?

Is there some body who knows about your TB status who can support you in treatment? ¤ªÀÄä n.© aQvÉìAiÀÄ §UÉÎ w½¢zÀÄÝ, CªÀgÀÄ aQvÉìUÉ ¨ÉA§°¸ÀÄvÁÛgÁ

Did you face any crisis recently in the family or any plan of social event in near future? EwÛÃa£À ¢£ÀUÀ¼À°è PÀÄlÄA§zÀ°è AiÀiÁªÀÅzÁzÀgÀÄ ©PÀÌlÄÖ JzÀÄj¹¢ÝÃgÁ? CxÀªÁ ªÀÄÄA§gÀĪÀ ¢£ÀUÀ¼À°è AiÀiÁªÀÅzÁzÀgÀÆ ¸ÀªÀiÁgÀA¨sÀªÀ£ÀÄß AiÉÆÃf¹¢ÝÃgÁ?

Financial difficulties ºÀtPÁ¹£À vÉÆAzÀgÉUÀ½zÉAiÉÄÃ

The tool to assess patients’ risks and needs

11

Social security needs Assessment ¸ÁªÀiÁfPÀ ¨sÀzÀævÀ CªÀ±ÀåPÀvÉUÀ¼À CAzÁdÄ

Social entitlements¸ÁªÀiÁfPÀ ¸ÀªÀ®vÀÄÛUÀ¼ÀÄ

Specify Details«ªÀgÀUÀ¼À£ÀÄß £ÀªÀÄÆ¢¹

Have this? Y/N/NA

EzÀÄ EzÉAiÉÄÃ? ºËzÀÄ/E®è

Need support for availing this? Y/N

¸ÀªÀ®vÀÄÛUÀ¼À£ÀÄß ¥ÀqÉAiÀÄ®Ä ¨ÉA§® ¨ÉÃPÉÃ? ºËzÀÄ/E®è

If linked through program, date of linkage

PÁAiÀÄðPÀæªÀÄzÀ ªÀÄÆ®PÀ eÉÆÃqÀuÉAiÀiÁVzÀÝgÉ eÉÆÃqÀuÉAiÀiÁzÀ ¢£ÁAPÀ

Aadhar Card DzsÁgï PÁqïð

Bank Account ¨ÁåAPï SÁvÉ

Ration Card ( APL/ BPL) ¥ÀrvÀgÀ aÃn (J¦J¯ï/©¦J¯ï)

DBT linkage r©n ¸ÉêÉUÉ eÉÆÃqÀuÉ

Link to free TB medicines (for Patients on private treatment) GavÀ n.©. OµÀ¢üUÀ½UÉ eÉÆÃqÀuÉ (SÁ¸ÀV aQvÉì ¥ÀqÉAiÀÄÄwÛgÀĪÀªÀjUÉ ªÀiÁvÀæ

Nutrition support ¥Ë¶ÖPÀ DºÁgÀ ¨ÉA§®

Anthyodaya C£ÀߨsÁUÀå CAvÉÆåÃzÀAiÀÄ

ICDS L¹rJ¸ï/CAUÀ£ÀªÁr ¸ÉêÉUÀ¼ÀÄ

Others EvÀgÉ

Livelihood support fêÀ£ÉÆÃ¥ÁAiÀÄPÉÌ ¨ÉA§®

Income generation activity DzÁAiÀÄ UÀ½PÉAiÀÄ ZÀlĪÀnPÉUÀ¼ÀÄ

Pension schemes ¦AZÀt AiÉÆÃd£ÉUÀ¼ÀÄ

Health related schemes (Health Insurance etc) DgÉÆÃUÀå¥ÀgÀ AiÉÆÃd£ÉUÀ¼ÀÄ (DgÉÆÃUÀå «ªÉÄ ªÀÄÄAvÁzÀªÀÅ)

Janani Suraksha Yojana (JSY) d£À¤ ¸ÀÄgÀPÀë AiÉÆÃd£É (eÉJ¸ïªÉÊ)

Rashtriya Swasthya Bima Yojana(RSBY) gÁ¶ÖçÃAiÀÄ ¸Áé¸ÀÜöå «ªÉÄ AiÉÆÃd£É (DgïJ¸ï©ªÉÊ)

Other state related health schemes gÁdåPÉÌ ¸ÀA§A¢ü¹zÀ EvÀgÀ DgÉÆÃUÀå AiÉÆÃd£ÉUÀ¼ÀÄ

Other health insurance schemes EvÀgÀ DgÉÆÃUÀå «ªÉÄ AiÉÆÃd£ÉUÀ¼ÀÄ

Any other schemesEvÀgÀ AiÉÆÃd£ÉUÀ¼ÀÄ

Risk factor C¥ÁAiÀÄPÁj CA±ÀUÀ¼ÀÄAssess if present

(Y/N)

Action Taken(Y/N)

Details of Action taken PÉÊUÉÆAqÀ PÀæªÀÄUÀ¼À «ªÀgÀ

4. About treatment (aQvÉìAiÀÄ §UÉÎ) Problem with access to drugs OµÀzsÀ ¥ÀqÉAiÀÄ®Ä vÉÆAzÀgÉ EzÉAiÉÄÃ?

Were you irregular to treatment previously? F »AzÉ ¤ÃªÀÅ aQvÉìAiÀÄ£ÀÄß ªÀÄzsÉå ªÀÄzsÉå ©nÖ¢ÝÃgÁ?

Symptoms persisting »A¢zÀÝ ®PÀëtUÀ¼ÀÄ FUÀ®Æ EªÉ

Patients preferred mode of care and support DgÉÊPÉ ªÀÄvÀÄÛ ¨ÉA§® «zsÁ£ÀzÀ°è gÉÆÃVUÀ¼À DzÀåvÉ In Person THALI RNTCP JEET Support Group

TB Care line Technology based support (99 DOTS, Etc). Call centre

Facility / provider Support Self-monitored/ Family supported only Other (Specify) ……...………

I....…………….......................... agree to this option/s for follow up £Á£ÀÄ................................................................C£ÀĸÀgÀuÉUÁV F DAiÉÄÌ/UÀ¼À£Àß M¦àgÀÄvÉÛãÉ.

Signature of the patient:

Risk And Needs Assessment done by: C¥ÁAiÀÄzÀ CA±ÀUÀ¼À ªÀÄvÀÄÛ CªÀ±ÀåPÀvÉUÀ¼À CAzÁd£ÀÄß £ÀqɹzÀÄÝ

Project: THALI JEET RNTCP Name: ºÉ¸ÀgÀÄ....................................................................................................................................................................................... ......... Designation: ºÀÄzÉÝ............................................................ Staff Id: ¹§âA¢ UÀÄgÀÄvÀÄ………………………………………...................................……..

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Disclaimer: This brief is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of KHPT and do not necessarily reflect the views of USAID or the United States Government.

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